Turkish Journal of Urology
UROONCOLOGY - Original Article

Biopsy with Ureterorenoscopy Before Radical Nephroureterectomy is Associated with Increased Intravesical Recurrence in Urothelial Cancer Located in the Kidney

1.

Department of Urology, İstanbul Medeniyet University Faculty of Medicine, İstanbul, Turkey

2.

Department of Urology, İstanbul Göztepe Prof. Dr. Süleyman Yalçın City Hospital, İstanbul, Turkey

3.

Department of Urology, University of Health Sciences, İzmir Tepecik Training and Research Hospital, İzmir, Turkey

4.

Department of Urology, University of Health Sciences, Bakirkoy Sadi Konuk Training and Research Hospital, İstanbul, Turkey

5.

Department of Urology, University of Health Sciences, Haydarpasa Numune Training and Research Hospital, İstanbul, Turkey

6.

Department of Urology, University of Health Sciences, Prof. Dr. Cemil Taşçıoğulu City Hospital, İstanbul, Turkey

7.

Department of Urology, University of Health Sciences, Diskapi Yıldırım Beyazıt Training and Research Hospital, İstanbul, Turkey

8.

Department of Urology, University of Health Sciences, Ümraniye Training and Research Hospital, İstanbul, Turkey

9.

Department of Urology, University of Health Sciences, Sultan 2. Abdulhamid Han Training and Research Hospital, İstanbul, Turkey

10.

Department of Urology, University of Health Sciences, Şişli Hamidiye Etfal Training and Research Hospital, İstanbul, Turkey

11.

Department of Urology, University of Health Sciences, Haydarpaşa Training and Research Hospital, İstanbul, Turkey

Turk J Urol 2022; 48: 431-439
DOI: 10.5152/tud.2022.22143
Read: 288 Downloads: 22 Published: 01 November 2022

Objective: Diagnostic ureterorenoscopy is used to identify upper tract urothelial cancer before radical nephroureterectomy, especially for uncertain lesions in imaging modalities or urine cytology. However, diagnostic ureterorenoscopy can potentially cause intravesical tumor spillage and can increase intravesical recurrence rates. We aimed to investigate the impact of diagnostic ureterorenoscopy before radical nephroureterectomy, with and without biopsy, on intravesical recurrence rates of patients with upper tract urothelial cancer.

Material and methods: Patients with localized upper tract urothelial cancer from 8 different tertiary referral centers, who underwent radical nephroureterectomy between 2001 and 2020, were included. Three groups were made: no URS (group 1); diagnostic ureterorenoscopy without biopsy (group 2); and diagnostic ureterorenoscopy with biopsy (group 3). Intravesical recurrence rates and survival outcomes were compared. Univariate and multivariate Cox regression analyses were performed to determine the factors that were associated with intravesical recurrence-free survival.

Results: Twenty-two (20.8%), 10 (24.4%), and 23 (39%) patients experienced intravesical recurrence in groups 1, 2, and 3, respectively (P=.037) among 206 patients. The 2-year intravesical recurrence-free survival rate was 83.1%, 82.4%, and 69.2%, for groups 1, 2, and 3, respectively (P=.004). Cancer-specific survival and overall survival were comparable (P=.560 and P=.803, respectively). Diagnostic ureterorenoscopy+biopsy (hazard ratio: 6.88, 95% CI: 2.41-19.65, P < .001) was the only independent predictor of intravesical recurrence in patients with upper tract urothelial cancer located in the kidney, according to tumor location.

Conclusion: Diagnostic ureterorenoscopy+biopsy before radical nephroureterectomy significantly increased the rates of intravesical recurrence in tumors located in kidney. This result suggests tumor spillage with this type of biopsy, so further studies with different biopsy options or without biopsy can be designed.

Cite this article as: Culpan M, Cakici MC, Keser F, et al. Biopsy with ureterorenoscopy before radical nephroureterectomy is associated with increased intravesical recurrence in urothelial cancer located in the kidney. Turk J Urol. 2022;48(6):431-439.

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